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The Montefiore Patient Health Education Center provides our beneficiaries and caregivers with online access to easy-to-search listings on medical conditions, health and wellness and medications. Users can view and print the most up-to-date information on over 35,000 health information topics. Content is well illustrated and provided in English and Spanish. Click to enter the Patient Health Education Center

For more information or questions about the topics and articles below, call the Care Guidance^SM Program at 1-888-667-8447. The Care Guidance Program also publishes a quarterly beneficiary newsletter, Care Connections. Look for the Spring 2007 edition in your mailbox in April.

PLAN FOR THE FUTURE: ADVANCED DIRECTIVES

Most people today live a long life. As you age, you may become less able to take care of yourself and less able to make health care decisions on your own. No one ever plans to be sick or disabled. Yet, it’s just the kind of planning that can make all the difference.

There are many different types of legal documents that can help you plan how your affairs will be handled in the future. Advance Directives are legal documents used to describe your health care wishes. Advance Directives include documents such as a Living Will and a Health Care Proxy.

The Care Guidance Program is committed to providing education and assistance with documentation regarding Advance Directives.

ADVANCE DIRECTIVES...

• Are for everyone, not just older adults or the chronically ill.
• Reflect your decisions, personal wishes, values and beliefs.
• Forms are free and do not require a lawyer.
• Can be cancelled at any time.
• Work best when accompanied by discussions with family or loved ones about your wishes.
• Can help guide your loved ones if they need to make decisions on your behalf and lessen the burden of this responsibility.

The following are questions that you may have already been asked by a Care Guidance staff member. Please read through them and use them to help you complete your Advance Directives if you have not done yours yet.

WHAT IF you were too ill to speak for yourself? Have you chosen anyone to make health care decisions for you? Have you filled out a Health Care Proxy Document?

• A Health Care Proxy allows you to appoint someone you trust – a Health Care Agent – to make health care decisions on your behalf if you are no longer able to do so. Your Health Care Proxy is obligated to make health care decisions based on your wishes. New York State Law requires that you fill out a Health Care Proxy form to appoint your Health Care Agent.

WHAT IF you were too sick to make decisions for yourself? Have you documented what your wishes are regarding any medical treatments you would or would not want done to you?

• A Living Will is a document that lets you state your wishes about how you want your health care handled if you are in a life-threatening situation and cannot make medical decisions for yourself. It gives you the right to refuse certain types of care. It also gives those caring for you the legal right to follow your wishes. It is effective only while you are unable to make or communicate your own healthcare decisions.

WHAT IF you could no longer eat or swallow safely? Would you want your life prolonged with a feeding tube?

• In New York State, unless your Health Care Proxy reasonably knows your wishes about artificial nutrition and hydration, he or she will not be allowed to participate in these decisions. Your wishes regarding this specific issue should be discussed with your Health Care Proxy AND clearly documented in your Living Will.


• Filling out a Do Not Resuscitate Form while in the hospital is not the same thing as filling out Advance Directive Forms. The “Do Not Resuscitate” Form is in effect for that hospitalization only and does not carry over to the community or to the next admission. If you are hospitalized again, you will need to fill out a new “Do Not Resuscitate” form, if that is what you choose.

Health Care Proxy and Living Will forms are free.
Visit www.caringinfo.org/files/public/NewYork.pdf to get the forms online. Remember, both forms need to be witnessed. Please be sure to give a copy of both forms to your Physician(s) and your Health Care Proxy.

EVERYONE BENEFITS FROM EXERCISE

New information from health related studies indicates that people of all ages and physical conditions benefit from exercise and physical activity. Exercise can help older adults feel better and enjoy life more, even those who think they're too old or too out of shape.

If you are already exercising... congratulations and please keep up the good work! If you are not active, it is NEVER too late to start! Exercise can help prevent loss of function, improve your strength, your balance and even your mood. Maintaining or increasing muscle strength can help you continue to do even the simple things, like getting up from a chair.

Don’t Be Afraid to Exercise
Exercise and physical activity are among the healthiest things older adults can do for themselves, but some are reluctant to start. They may be concerned that exercise could be too strenuous or will harm them. Older adults hurt their health far more by not exercising and can lose ground in four areas that are important for staying healthy and independent: strength, balance, flexibility, and endurance. Exercise may also help to improve breathing, increase energy, control weight, strengthen bones and muscles, reduce stress, improve sleep, and increase the body’s ability to fight off colds and other viruses.

Tips to Get Started

• Consult your health care provider if you are considering a major change in your activity level and discuss goals that are safe for you.


• Pump yourself up. Keep reminding yourself of all the good things that come with physical activity.


• Do what feels good. Choose an activity you like. That way, you're more likely to stick with it.


• A little activity goes a long way; about 30 minutes several days a week, and this can be broken into shorter 10 minute episodes.


• Start slowly. Don't try to do too much at once, especially if you have
  a health problem. For example, park further away from the
  grocery store, watch less television, pull some weeds or take a
  walk with your grandchild.


• Watch for new or worsening symptoms such as dizziness, shortness of breath or chest pain, and notify your physician.


• Monitor yourself. If you can talk without any trouble, you are not working hard enough. If you can’t talk at all, it’s too hard.

And Don’t Forget Your Feet

• Your shoes should have a sturdy, nonskid sole that is not too thick.
• Have your feet measured every time you buy shoes.
• Females should avoid heels and shoes that are too small.
• Shoes with laces are safer than slip on and velcro is good if you are unable to use laces.
• Keep toenails trimmed and watch for any sores or blisters from your footwear.

In one study, seniors over age 65, wearing canvas athletic shoes (sneakers) were least likely to suffer falls and being barefoot had a higher risk of falling.

PREVENTING FALL-RELATED INJURIES

Have you fallen in the past six months?
This is an important question we ask in our participant interview. We ask it because people who have had a fall are at higher risk of falling again and we would like to help prevent future falls and injuries. More than one third of adults over the age of 65 fall each year and most of these falls occur in the home. There is usually more than one reason for someone falling. Side effects from medications, problems with vision, medical conditions that affect balance and/or poor lighting may all combine to cause a fall. Serious injuries can occur, such as fractured bones or head trauma.

You CAN reduce your chance of falling in several different ways. It may be as simple as wearing more appropriate footwear and picking up throw rugs in your home. However, for some of our participants we may recommend that you be referred to the Falls Prevention Program.

What is the Falls Prevention Program?
The Falls Prevention Program is run by the Montefiore Medical Center Division of Geriatric Medicine. Geriatricians are physicians who specialize in the care of older adults. If you are at high risk for falling, we may suggest a consultation with a geriatrician from the Falls Prevention Program. Care Guidance Outreach Specialist, Samantha Torres, can schedule the appointment. You would be evaluated with a focus on any problems or conditions that could be contributing to your risk of falling. The geriatrician may make recommendations, which will also be communicated back to your primary care physician, if appropriate. Recommendations might include: physical therapy, adjusting your medications, adaptive equipment, foot care or having your hearing and vision checked. The Care Guidance Staff would also be available to assist you with any of the recommendations offered.

What should you do if you fall?
If you have any injuries please seek immediate treatment. Even if you do not hurt yourself, please let your physician and the Care Guidance Program Staff know that you have fallen. We can work with you to help prevent another fall. If you would like to learn more about how to prevent falls, be sure to click the link and read “Age Page: Preventing Falls and Fractures.”

GETTING A FLU SHOT IS NOTHING TO SNEEZE AT

Did you know that each year, more than 200,000 people are hospitalized and approximately 36,000 die due to complications from the flu? That is why it is recommended that people over the age of 50, especially those over 65 and anyone with chronic conditions such as diabetes, breathing disorders or heart disease get a flu shot. Remember - You can’t get the flu from the flu shot!

At the end of October 2006, we mailed you a flyer with important information about getting a flu shot. After we mailed the flyers, we called all of our participating beneficiaries to find out if they got their flu shot and if not, why. We are happy to report that of the participants we were able to reach on the phone, 77% reported that they had received a flu shot. 23% told us that they did not plan to get a flu shot mostly because they were allergic to the vaccine, too sick, or thought they would get the flu from the shot.

For many people, getting the flu shot means staying healthy through the winter, so you should consider getting the flu shot if it’s right for you. Talk to your primary healthcare provider if you have any questions or concerns, or call the Care Guidance Program at 1-888-667-8447.

Flu Shot Flyer - English
Flu Shot Flyer - Spanish

CAREGIVER CORNER

Do you help to care for a frail or elderly person? Be sure to read Caregiver Corner in each Care Connections newsletter or check here for new tips.

Being a caregiver for someone you love is one of the greatest gifts you can give, but it can also be very stressful. As you care for your loved one, there are resources that can help and things you can do to ease the strain on your own health and well-being. Here are some ways to care for yourself while caring for your loved one:

• Realize that your health matters – it benefits everyone if you stay healthy and less stressed. Visit your doctor every year for a check up.


• Be aware of the toll stress takes on your health. Try to find time for exercise, eating well and sleeping enough.


• Talk to your doctor if you feel depressed or anxious. Signs that you may need help include crying more, sleeping more or less than usual, changes in appetite, and lack of interest in your regular activities.


• Learn about the condition your loved one is facing and how it may affect his/her physical and emotional state.


• Find out about sources of support and help in your community. Reach out to family members, friends, neighbors, your place of worship, your Area Agency on Aging or your workplace for help with caregiver tasks.

Adapted from Rx for Caregivers: It is Important to Care for Yourself by Richard H. Carmona, M.D., M.P.H., Surgeon General of the United States

Prevent Falls! Look and Think Before You Leave
Running out to work? Maybe to buy groceries? Before leaving someone you care for, consider and remove any potential for falls. Here are some simple steps you can take to reduce their risk of falling: Speak with him or her about their needs while you are away. If they need assistance with toileting, make sure they go before you leave. If they use a walker, cane or wheelchair, place the piece of equipment nearby so that it is easy to reach. Place the telephone, a pen and paper close to them. Remind him or her to change positions slowly. Consider buying a Personal Emergency Response System (PERS) so that they can get help if they do happen to fall while you are away. Taking the time to do these things can go a long way in preventing falls or reducing the impact of an unavoidable fall.

If you would like more information or assistance, or would like to learn more about PERS, call the Care Guidance Team at 1-888-667-8447.

COMMUNITY RESOURCE CENTER

Walking is an easy and fun way to stay fit, especially when you walk with friends. The Big Apple Senior Strollers Walking Clubs offer a great opportunity to enjoy the benefits of walking, as well as the company of friends.

These walking clubs are active in a variety of facilities that provide services to seniors throughout New York City. Each club walks to achieve a target number of steps, anywhere from 25,000 to 100,000. Every Big Apple Senior Stroller can help their club meet its target and improve his or her physical fitness by gradually increasing the number of steps that they take whenever their club is out walking. Each member of a club uses a pedometer to count their steps and their individual totals contribute to their club’s goal.

To find a Walking Club near you, contact Barbara Bruno at the Care Guidance Program, 1-888-667-8447, ext. 4120. You must become a member of a senior center before you can join its club. Please check with your doctor before joining a club.

The Bronx House Community Center, located at 990 Pelham Parkway South, Bronx, N.Y. 10461 (tel. 718-792-1800) also offers a wide variety of fitness programs including a state of the art fitness center, heated indoor swimming pool, and gymnasium, with activities designed for those from young to old.

For additional information and resources, visit the following websites:
www.aging.state.ny.us
www.nyc.gov/aging
www.aarp.org

For more information on the Care Guidance Program, call us at 1-888-667-8447.